How to Heal Depression

Part One:
Understanding Depression

Fourteen: How Did Annie Hall Get Her Name?

The original title for Woody Allen's film Annie Hall was Anne Hedonia.

"Sometimes [depression] is mere passive joylessness and dreariness, discouragement, dejection, lack of taste and zest and spring," wrote the father of American psychology, William James, in 1902. "Professor Ribot has proposed the name anhedonia to designate this condition."

Anhedonia was derived from the Greek: an , meaning not, and hedone, meaning pleasure--the inability to experience pleasure.

If it's been a while since you've genuinely enjoyed your life (or can't relate much to the terms enjoyment, pleasure, or fun), that may indicate depression.

Fifteen: Other Types of Depression

In addition to the Big Three we discussed on page 20--major depression, chronic low-grade depression (dysthymia), and manic-depression--there are some other types of depression:

• Seasonal Affective Disorder (SAD). This seems to be associated with the reduction of daylight hours during winter. The treatment may be as simple as installing full-spectrum fluorescent lighting in the home and workplace. (New Yorkers have been prescribing for themselves winter trips to Miami for generations.)
• Postpartum Depression. Fifty to seventy- five percent of all women, following childbirth, experience "postpartum blues." One in ten women who experience this, however, develop a postpartum depression. This means that from five to seven and one-half percent of all new mothers have a depression that requires treatment. Postpartum depression seems to be caused by the hormonal, physiological, and emotional vulnerabilities of this period. If the normal "postpartum blues" seem particularly severe, or they continue for more than a few weeks, discuss it with your doctor.
• Atypical Depression. Atypical not typical) depression has symptoms which seem to be the opposite of what was once thought to be a typical depression. Rather than sleeping less, people sleep more; rather than lose weight, they gain weight; rather than have low energy, they're agitated. In addition, people with atypical depression tend to be extremely sensitive to rejection.
• Double Depression. Here someone with a chronic low-grade depression (dysthymia) has a major depression as well. As we previously noted, chronic depressions can go on for years, even decades, while major depressions have a beginning, a middle, and an end. During the time one has both chronic depression and a major depression, it's a double depression.

A psychiatrist or physician well versed in diagnosing depression will know the symptoms to look for in determining which depression you may have.

(Please don't use this brief list to try to categorize or diagnose yourself or others. It is presented here simply to give an idea of the range and varieties depressive illness can take.)

Sixteen: Delay Major Decisions--Depression Alters Perception

It's important to remember that when depressed, we are not perceiving the world, or ourselves, accurately. Therefore, evaluations, judgments, and decisions may be inaccurate.

If you think you may be depressed, the only major decision to make is to get a diagnosis and, if diagnosed as depressed, to get treatment. Other major decisions can wait until the depression begins to heal.

Seventeen: The Question of Suicide

It is very common for depressed people to have thoughts and feelings of suicide. Such thoughts and feelings are, in fact, a symptom of depression.

For obvious reasons, however, it is important not to act upon suicidal thoughts or feelings.

Sadly, fifteen percent of all depressed people will commit suicide as a result of their depression. Two-thirds of all suicides are directly related to depression.

If you feel you even may act upon suicidal thoughts or feelings, call a crisis prevention line, your family doctor, a good friend, or any healthcare professional at once. Go to an emergency room, or call 911 and say, "I'm feeling suicidal. Please help."

As your depression heals, life improves; you will no longer feel like committing suicide.

Yes, life will still have its ups and downs, and you will feel your fair share of sadness, anger, grief, fear, and all the other "down" emotions. As depression heals, however, suicide will seldom seem the only solution.

The question of suicide? Keep it a question. It's not really an answer.

Eighteen: The Power of Positive Thinking Crashes and Burns in the Face of epression

As powerful as the power of positive thoughts are, depression biologically interferes with the brain's ability to maintain a positive thought for any period of time. Like the farmer who casts his seed upon the rocks, all the positive thoughts in the world presented to the depressed mind will not bear fruit.

"There are joys which long to be ours," wrote Henry Ward Beecher. "God sends ten thousand truths, which come about us like birds seeking inlet; but we are shut up to them, and so they bring us nothing, but sit and sing awhile upon the roof, and then fly away."

Depression shuts us up.

Overly positive, horrendously cheerful people can make a depressed person even more depressed. In fact, perhaps the least helpful thing one can say to a depressed person is, "Cheer up!"

When thinking is distorted, as it is during depression, medical treatment is needed to till the soil so that positive thoughts can take root.

Nineteen: God and Depression

Here we use the word God in the broadest possible sense. Please fill in your personal belief when we use the word God.

There are many misconceptions concerning God and depression. These include:

• Depression is a punishment from God.
  
• To seek help for depression is to doubt God's ability to heal it.
  
• If we "suffer enough," God will be pleased with us.
  
• Depression is a spiritual illness; the only treatment should be God's personal intervention.

In fact (or at least it seems a fact to us), God and God's benevolence come in many forms and manifest in many ways. Among these we must include modern science and the entire healing profession. (God moves in mysterious ways; psychiatrists are just one of them.)

It is hard to find the believer who will not take penicillin for pneumonia, insulin for diabetes, or have a broken bone properly set.

The overwhelming majority of people who are successfully treated for depression find that their faith, spiritual connection, and perception of divine goodness increase.

Modern treatment of depression is a gift of God.

Twenty: What Causes Depression?

Depression manifests as an imbalance in the biochemistry of the brain. This results in what some call "faulty thinking." This combination of biological imbalance and psychological distortion causes the havoc known as depression.

A depression can be triggered--that is, set off--by any number of factors: genetic predisposition, major loss, a painful childhood, unresolved grief, stress, serious illness, economic difficulties, bad relationships, and so much more. These are, however, merely what sets off the depression.

The state of "being depressed" (having a depressive illness) takes place in the brain: a biochemical imbalance in the brain and a psychological imbalance in thinking.

Let's explore each in greater detail.

Twenty-one: The Messengers of the Brain

The human brain is the most intricate, complex, and exquisite communication center on earth. Ten billion brain cells transmit billions of messages each second. And, as Alan Watts pointed out, "It does all this without our even thinking about it."

The biochemical messengers of this communication are known as neurotransmitters. (Neuro refers to the brain cells and transmitter , to sending and receiving information.)

When neurotransmitters are at appropriate levels, the brain functions harmoniously. We tend to feel good. We have hope, purpose, and direction. Although we certainly experience the ups and downs of life, the overall mood is one of well-being, confidence, and security.

Although there are dozens of different neurotransmitters, research indicates that a deficiency in some of the neurotransmittersserotonin, norepinephrine, and dopamine may be one cause of depression. On the other hand, excess amounts of neurotransmitters may be a cause of the manic phase of manic-depression.

Restoring these neurotransmitters to natural levels by way of antidepressant medication brings the brain back into harmonious functioning and a return to well-being.

Twenty-two: The Mind and Its Negative Thoughts

Negative thoughts can play an important role in depression. Such thoughts can become a bad habit. For some, they become an addiction.

Some common negative thoughts include

• "I'm no good."
• "No one understands me."
• "Life isn't fair."
• "I don't dare do that."
• "How dare they do that?"
• "I hate it when ... ."
• "I'm afraid that ... ."
• "I'm a failure."

These can lead to habitual, often addictive behavior, such as

• Overeating
• Drug abuse
• Alcoholism
• Smoking
• Compulsive gambling
• Shoplifting
• Sexual compulsions
• Workaholism

And many more.

Habitual patterns of negative thoughts and self-destructive behavior can cause, continue, or worsen a depression.

Twenty-three: Which Came First?

So, depression manifests itself as a biochemical imbalance in the brain and as negative thoughts in the mind. But where does depression begin? Which manifestation is the "first cause" of depression?

The answer: it doesn't really matter.

A deficiency of neurotransmitters can contribute to negative thoughts and behaviors. And, negative thoughts and behaviors can contribute to a reduction in neurotransmitters. Whichever started the depression, it becomes a downward spiral, one feeding the other into a deepening gloom.

Which came first, then, is not important. What to do about depression is. Antidepressant medication helps restore the proper balance of neurotransmitters in the brain. Certain short-term therapies (most particularly Cognitive and Interpersonal therapies) teach new habits of thought and action. The medical (brain) and psychotherapeutic (mind) approaches have, individually, been successful in treating depression.

Some prefer to approach healing from one angle; others prefer to approach it from the other. Gluttons for happiness that we are, we suggest you consider both.

Combining therapies appears to be the most successful treatment of all.

Twenty-four: Depression Can Be Hereditary and "Contagious"

Like many illnesses, depression runs in the family. Heart disease, hypertension, and depression are among the illnesses that are common to certain family trees.

Living with someone who is chronically depressed can be depressing. When a relative or loved one has recurrent episodes of depression, there is a profound disruption of family life. Family members experience pain, exhaustion, and are more prone to depression.

"Misery no longer loves company," Russell Baker observed. "Nowadays it insists upon it."

Twenty-five: Depression Related to Age

Depressions can take place at any age. Infants can have depression, as can people well into their second century on earth.

About six million American children under twelve have a clinical depression, much of it unrecognized and untreated. Sometimes behavior diagnosed as an Attention Deficit Disorder (children who are easily distracted, hyperactive, and have difficulty paying attention) is, in fact, depression.

One in twenty adolescents suffers from depression. Hormonal changes, emerging identity crises, peer pressure, sexual issues, and the increased responsibility of approaching adulthood can contribute to depression. Tragically, the suicide rate among teenagers has almost tripled in one generation.

The generation from eighteen to thirty sometimes called Generation-X realizes it may be the first generation in the history of the United States to be less affluent than the generation before. Many who make up Generation-X are also keenly aware of the condition of the country and planet being passed on to them. Understandably, many are not happy about it. For some individuals, this unhappiness deepens into a depression.

The ubiquitous baby boomers--some in their forties, some in their fifties, and most in denial--find that they have become their parents. All the problems, crises, and attitudes they so despised in their parents have come home to roost. In addition, the post-war generation is discovering that, like Peter Pan exiled from Never-Never Land, youth is not eternal. And then there's that icky thing called death. All of this leads to what has been dubbed the Baby Boomer Blues.

People over sixty-five are four times more likely to experience depression than the general population. Tragically, many elderly people are believed to have early stages of senility or Alzheimer's disease when, in fact, they have a treatable depression.

Too often, the symptoms of depression from physical aches and pains to poor memory--are written off as "just growing old." While certain physical and mental problems may arise due to aging, they may also be symptoms of depression that should be carefully evaluated by a physician.

Above all, it is never normal to feel unhappy day after day, simply because you're growing older.

The National Institutes for Health have free pamphlets for depression written for various age groups. Please call 1-800-421-4211 for your copy.

Copyright © 1994-1996 Harold H. Bloomfield, M.D. & Peter McWilliams

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